Nebivolol + Hydrochlorothiazide

Indications

Nebivolol + Hydrochlorothiazide is used for: Hypertension

Adult Dose

Oral Hypertension Adult: Per tablet contains nebivolol 5 mg and hydrochlorothiazide 12.5 mg: 1 tablet once daily.

Child Dose

Renal Dose

Administration

Contra Indications

Hypersensitivity, liver impairment, anuria, sulphonamide allergy. Pregnancy, lactation.

Precautions

History of allergies, psoriasis, hyperthyroidism, peripheral arterial disease, diabetes, existing electrolyte disturbances, oedema, renal impairment, hyperlipidemia,hyperuricaemia. Elderly.

Pregnancy-Lactation

Interactions

Symptomatic hyponatraemia when combined with carbamazepine. Predisposes to allopurinol sensitivity reactions and impaired renal function. Potentiates hypotensive effect of beta blockers and ACE inhibitors; these also reduce diuretic-induced hypokalaemia. Potentially Fatal: Enhance neuromuscular blocking action of competitive muscle relaxants. Cross-allergy with sulphonamides and sulphonylurea hypoglycaemics with resultant acute interstitial nephritis and vasculitis. Potentiates bone-marrow suppression caused by anticancer drugs. Potentiates aminoglycoside nephrotoxicity. Impaired control of diabetes by oral hypoglycaemic agents. May precipitate digitalis toxicity and lithium toxicity. Increased risk of hypokalaemia with corticosteroids. Prolongs paralysis caused by tubocurarine.

Side Effects

Side effects of Nebivolol + Hydrochlorothiazide : Nebivolol - Headache, fatigue, parasthesias, dizziness. Hydrochlorothiazide - Hypotension including orthostatic hypotension, pancreatitis, intrahepatic cholestatic jaundice, diarrhoea, vomiting, sialadenitis, cramping, constipation, gastric irritation, nausea, anorexia, thrombocytopenia, photosensitivity, fever, urticaria, rash, purpura, hyperglycemia, glycosuria, hyperuricemia, restlessness, impotence. Potentially Fatal: Seizures, may unmask diabetes mellitus. Hyponatraemia and idiosyncratic, hypersensitivity reactions.

Mode of Action

Nebivolol exerts its actions by exhibiting a high selectivity for beta-1 adrenergic receptors and also by reducing the peripheral vascular resistance by modulating nitrous oxide release. Hydrochlorothiazide inhibits the reabsorption of Na and chloride at the beginning of distal convoluted tubule. It causes natriuretic effect mainly by decreasing Na and chloride reabsorption in the cortical segment of the ascending limb of the Loop of Henle by inhibition of a specific Na+Cl- co-transporter.